A Community Health Needs Assessment Prepared for VCU Community Memorial Hospital By Community Health Solutions December 2015

Transcription

1 A Community Health Needs Assessment Prepared for VCU Community Memorial Hospital By Community Health Solutions December 2015

2

3 Section Table of Contents Page Executive Summary 1 Part I. Community Insight Profile 5 Item 1. Survey Respondents 5 Item 2. Community Health Concerns 6 Item 3. Community Service Gaps 8 Item 4. Community Specialty Medical Care Service Gaps 10 Item 5. Vulnerable/At-Risk Populations in the Community 11 Item 6. Vulnerable/At-Risk Regions in the Community 13 Item 7. Additional Ideas and Suggestions 14 Part II. Community Indicator Profile Health Demographic Trend Profile Health Demographic Snapshot Mortality Profile Maternal and Infant Health Profile Preventable Hospitalization Profile Behavioral Health Hospital Discharge Profile Adult Health Risk Factor Profile Youth Health Risk Factor Profile Uninsured Profile Medically Underserved Profile 27 Appendix A: Zip Code Level Maps 28 Appendix B: Data Sources 45

4

5 Executive Summary The mission of VCU Community Memorial Hospital is to "provide excellence in the delivery of healthcare. With this mission in mind, VCU Community Memorial Hospital commissioned Community Health Solutions to conduct this community health needs assessment in The study focuses on the VCU Community Memorial Hospital service area of 38 zip codes, most of which fall within Brunswick, Charlotte, Lunenburg, Mecklenburg and Nottoway counties. The study region is shown in the map below. The results include two primary components: a community insight profile based on qualitative analysis of a survey of community stakeholders, and a community indicator profile based on quantitative analysis of community health status indicators. This Executive Summary outlines major findings, and details are provided in the body of the report. The Study Region Part I. Community Insight Profile In an effort to generate community input for the community health needs assessment, a Community Insight Survey was conducted with a group of community stakeholders identified by VCU Community Memorial Hospital. The survey participants were asked to provide their viewpoints on: Important health concerns in the community; Significant service gaps in the community; Specialty medical care service gaps in the community; Vulnerable/at-risk populations in the community; Vulnerable/at-risk regions in the community; and Additional ideas or suggestions for improving community health. 1 VCU Community Memorial Hospital Community Health Needs Assessment

6 The survey was sent to a group of 427 community stakeholders. A total of 76 (18%) submitted a response (although not every respondent answered every question). The respondents provided rich insights about community health in the study region. To summarize: Health Concerns. The respondents identified over 20 important community health concerns including cancer; Alzheimer s Disease; heart disease; high blood pressure; stroke; adult obesity; diabetes; prenatal and pregnancy care; tobacco use; childhood obesity; and other concerns. Service Gaps. The respondents identified more than two dozen specific community services in need of strengthening, including long term care services; aging services; behavioral health services; cancer services; chronic pain management services; health insurance coverage; maternal, infant, and child health services; early intervention services for children; specialty medical care; primary health care; and other services. Community Specialty Medical Services Gaps. The respondents were asked to review a list of specialty medical services typically needed to address community healthcare needs. Identified gaps include cardiologists, dermatologist, family practice physicians, geriatricians, pediatricians, oncologists, urologists, and other specialists. Vulnerable or At-Risk Populations. The respondents were asked to identify particular populations who are vulnerable or at risk for health concerns or difficulty obtaining health services. Identified populations include the elderly; children; low income and unemployed or under-employed residents; persons without reliable transportation; and members of the Hispanic community. Vulnerable or At-Risk Regions. The respondents were also asked to identify vulnerable or at-risk neighborhoods or geographic regions in the community. Identified regions include rural areas generally, plus South Hill, Mecklenburg, Brunswick, Lunenburg, and several specific neighborhoods. (See Appendix A for zip-code level maps of selected demographic and health indicators for the region). Ideas and Suggestions. Thirty-three respondents offered open-ended responses with additional ideas and suggestions for improving community health. Part II. Community Indicator Profile The community indicator profile in Part II presents a wide array of quantitative community health indicators for the study region. To produce the profile, Community Health Solutions analyzed data from multiple sources. By design, the analysis does not include every possible indicator of community health. The analysis is focused on a set of indicators that provide broad insight into community health and for which there were readily available data sources. To summarize: Demographic Profile. As of 2014, the study region included an estimated 81,737 people. The population is expected to increase to 82,151 by Compared to Virginia as a whole, the study region is more rural, older, and more racially/ethnically diverse. The study region also has lower income and educational attainment among adults than Virginia as a whole Focusing on trends from 2010 to 2019, it is projected that population growth of 14 percent will occur in the senior population age 65+, with declining populations expected in other age groups. Focusing on race and ethnicity, growth is expected within the Asian, Other or Multi-Race, and Hispanic population groups, with declines expected in the White and Black/African American population segments. Mortality Profile. The study region had 1,080 total deaths in The leading causes of death were heart disease (275 deaths), malignant neoplasms (cancer) (255 deaths), and cerebrovascular disease (stroke) (83 deaths). The death rates in the study region (unadjusted for age) were higher than Virginia overall, and for the top seven causes of death. 2 VCU Community Memorial Hospital Community Health Needs Assessment

7 Maternal and Infant Health Profile. The study region had 778 total live births in Of these, 89 (11%) were born with low birth weight, 155 (20%) were births without early prenatal care, 407 (52%) were non-marital births, and 70 (9%) were births to teens [with most (56) involving older teens age 18 or 19]. Compared to Virginia as a whole, the study region had higher rates of low weight births, births without early prenatal care, and non-marital births. The five-year infant mortality rates were higher than the statewide rate for four of the five counties, the exception being Lunenburg County. Teen pregnancy rates were also higher than the statewide rate for four of the five counties, the exception being Mecklenburg County. 1 Preventable Hospitalization Profile. The Agency for Healthcare Research and Quality (AHRQ) identifies a defined set of conditions (called Prevention Quality Indicators, or PQIs ) for which hospitalization should be avoidable with proper outpatient health care. High rates of hospitalization for these conditions indicate potential gaps in access to quality outpatient services for community residents. residents of the study region had 1,705 PQI hospital discharges in The leading diagnoses for these discharges were chronic obstructive pulmonary disease (COPD) and asthma in older adults (449); congestive heart failure (445), Diabetes (240), and Bacterial Pneumonia (200). The PQI discharge rates for the study region were higher than the Virginia statewide rates PQI diagnoses overall and for the seven leading causes. Behavioral Health Hospital Discharge Profile. Behavioral health hospitalizations provide another important indicator of community health status. Residents of the study region had 626 hospital discharges from Virginia community hospitals for behavioral health conditions in The leading diagnoses for these discharges were affective psychoses (226), schizophrenic disorders (95), and Depressive Disorders (53). The BH discharge rates for the study region were higher than Virginia statewide rates overall and for four of the top five causes, the exception being a lower rate for schizophrenic disorder. Adult and Youth Health Risk Profiles. The study includes a set of estimates of adult and child health risk. The local estimates indicate that substantial numbers of adults in the study region may have health risks related to nutrition, physical activity, weight, tobacco, and alcohol. It is also estimated that large numbers of children in the study region are not meeting recommendations for healthy eating, physical activity and healthy weight. Uninsured Profile. An estimated 12,721 nonelderly residents of the study region were uninsured in Among both children and adults, the majority of uninsured residents were estimated to have incomes at or below 200% of the federal poverty level (FPL). Medically Underserved Profile. Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the U.S. Health Resources and Services Administration as being at risk for health care access problems. The designations are based on several factors including primary care provider supply, infant mortality, prevalence of poverty, and the prevalence of seniors age 65+. All five counties that overlap the study region have been designated as MUAs. 1 Infant mortality and teen pregnancy rates were not calculated for this study region because the study region is defined by zip codes, and available data are not structured to support calculation of rates at the zip code level. City/county level rates are provided as an alternative. 3 VCU Community Memorial Hospital Community Health Needs Assessment

8 Accompanying File of Zip Code Level Indicators This report includes community health indicators for the study region as a whole. A separate Microsoft Excel file contains indicators for each zip code within the study region. Appendix A: Maps Appendix A provides a set of thematically colored maps displaying variation in community health indicators by zip code. The maps are accompanied by a table of the same indicators. Appendix B: Trend Analysis of Priority Concerns Appendix B provides trend analysis of indicators for health concerns that were identified as priorities in the 2011 CHNA report. Appendix B: Data Sources Appendix B provides detail on the methods used to produce the indicators. 4 VCU Community Memorial Hospital Community Health Needs Assessment

9 Part I. Community Insight Profile In an effort to generate community input for the community health needs assessment, a Community Insight Survey was conducted with a group of community stakeholders identified by VCU Community Memorial Hospital. The survey participants were asked to provide their viewpoints on: Important health concerns in the community; Significant service gaps in the community; Specialty medical care service gaps in the community; Vulnerable/at-risk populations in the community; Vulnerable/at-risk geographic regions in the community; and Additional ideas and suggestions for improving community health. The survey was sent to a group of 427 community stakeholders. A total of 76 (18%) submitted a response (although not every respondent answered every question). The respondents provided rich insights about community health in the study region. The results are summarized in the remainder of this section. 1. Survey Respondents Exhibit I-1 below lists the organizational affiliations of the survey respondents. Exhibit I-1 Reported Organization Affiliation of Survey Respondents 2 AmeriCare Plus (2) Park View High School (2) Benchmark Community Bank R. T. Arnold Library BGF Industries Re/Max On The Lake Brunswick County Public Schools (2) Retired (2) Citizens Community Bank (4) School Board VCU Community Memorial Hospital (4) South Hill Enterprise Courier-Record Newspaper South Hill Volunteer Fire Department (2) Crowder-Hite-Crews Funeral Home South. Hill. Chamber Edward Jones Investments (2) Southside Appraisal Services Exit Town & Lake Realty (3) Southside Health District - Mecklenburg County Health Department FIRST CITIZENS BANK Southside Massage, LLC GLENN E. BARBOUR, P. C. Southside Medical Management Halifax Community College Southside PDC International Veneer Southside VA Community College (4) It's A Royal Affair Design & Marketing Jackson Hewitt SoVa Realty SVRMC Lake Country Area Agency on Aging (2) Team Nurse, Inc. Lake Gaston Regional Chamber of Commerce The Colonial Center for Performing Arts Lunenburg County Public Schools The Mecklenburg Sun MacCallum More Museum & Gardens Town of South Hill (5) Mary Baldwin College Virginia Senate Mecklenburg County Public Library Virginia Asset Management (2) Mecklenburg County Public Schools Virginia-Carolina Appraisal Co Mecklenburg Electric Cooperative (2) Unknown Organization (6) 2 A count is provided for organizations with multiple survey respondents. One respondent represented more than one organization. 5 VCU Community Memorial Hospital Community Health Needs Assessment

10 2. Community Health Concerns Survey respondents were asked to review a list of common community health issues. The list of issues draws from the topics in Healthy People 2020 with some refinements. The survey asked respondents to identify from the list what they view as important health concerns in the community. Respondents were also invited to identify additional issues not already defined on the list. Exhibit I-2 summarizes the results, including open-ended responses. Exhibit I-2 Important Community Health Concerns Identified by Survey Respondents Answer Options Response Percent 3 Response Count Cancer 91% 68 Note: When Alzheimer's Disease 79% 59 interpreting the Heart Disease 76% 57 survey results, please note High Blood Pressure 73% 55 that although Stroke 71% 53 the relative number of Adult Obesity 68% 51 responses Diabetes 68% 51 received for Prenatal & Pregnancy Care 57% 43 each item is instructive, it is Tobacco Use 53% 40 not a definitive Childhood Obesity 49% 37 measure of the relative Depression 48% 36 importance of Arthritis 45% 34 one issue Infant and Child Health 45% 34 compared to another. Mental Health Conditions (other than depression) 43% 32 Orthopedic Problems 41% 31 Substance Abuse - Illegal Drugs 40% 30 Dental Care/Oral Health-Pediatric 39% 29 Teen Pregnancy 39% 29 Dental Care/Oral Health-Adult 36% 27 Renal (kidney) Disease 35% 26 Substance Abuse - Prescription Drugs 35% 26 Alcohol Use 32% 24 Chronic Pain 32% 24 Injuries 32% 24 Neurological Disorders (seizures, multiple sclerosis) 31% 23 Respiratory Diseases (other than asthma) 31% 23 Asthma 28% 21 Physical Disabilities 24% 18 Autism 21% 16 Infectious Diseases 21% 16 Domestic Violence 20% 15 Intellectual/Developmental Disabilities 20% 15 Sexually Transmitted Diseases 13% 10 HIV/AIDS 12% 9 Environmental Quality 9% 7 Other Health Problems (see next page) 11% 8 3 Seventy-five (75) of the 76 survey respondents answered this question. 6 VCU Community Memorial Hospital Community Health Needs Assessment

11 Exhibit I-2 (continued) Important Community Health Concerns Identified by Survey Respondents (continued) Other Important Community Health Concerns Identified by Survey Respondents Response # Reponses 1. All items checked are critical health concerns for the community, especially the youth attending public schools. 2. At first I marked every box, then I tried to focus in on those that seems more widespread in their being problems. 3. Dermatology Dermatology 2. Support groups for people caring for aging parents, education on the aging process of parents and how to cope with them. 5. Skin diseases 6. The prevalence of cancer seems off the charts. 7. We have a lot of bad habits around here. Folks eat too much, smoke, and drink too much. 8. We have many children in our school system with asthma. Our numbers of autistic children are growing. Also parents need education about nutrition for their children; we have many children who have decaying teeth when they enter Pre-K. There is a great need for prenatal and pregnancy care (we have no obstetrician or pediatrician in our county) as well as education for teens concerning teen pregnancy and STDs. 7 VCU Community Memorial Hospital Community Health Needs Assessment

12 3. Community Service Gaps Survey respondents were asked to review a list of community services that are typically important for addressing the health needs of a community. Respondents were asked to identify from the list any services they think need strengthening in terms of availability, access, or quality. Respondents were also invited to identify additional service gaps not already defined on the list. Exhibit I-3 summarizes the results, including open-ended responses. Exhibit I-3 Important Community Service Gaps Identified by Survey Respondents Answer Options Response Percent 4 Response Count Long Term Care Services 62% 44 Aging Services 59% 42 Behavioral Health Services (including mental health, substance use and intellectual disability) 54% 38 Cancer Services (screening, diagnosis, treatment) 51% 36 Chronic Pain Management Services 42% 30 Health Care Insurance Coverage (private and government) 41% 29 Maternal, Infant & Child Health Services 41% 29 Early Intervention Services for Children 39% 28 Specialty Medical Care (e.g. cardiologists, oncologists, etc.) 38% 27 Primary Health Care Services 35% 25 Food Safety Net (food bank, community gardens) 34% 24 Health Care Services for the Uninsured and Underinsured 34% 24 Home Health Services 34% 24 Job/Vocational Retraining 34% 24 Chronic Disease Services (including screening and early 32% 23 detection) Patient Self-Management Services (e.g. nutrition, exercise, taking 32% 23 medications) Dental Care/Oral Health Services-Pediatric 31% 22 Health Promotion and Prevention Services 31% 22 Transportation 31% 22 Hospital Services (including emergency, inpatient and outpatient) 28% 20 School Health Services 27% 19 Dental Care/Oral Health Services-Adult 25% 18 Family Planning Services 23% 16 Hospice Services 23% 16 Domestic Violence Services 20% 14 Physical Rehabilitation 20% 14 Social Services 18% 13 Homeless Services 14% 10 Pharmacy Services 14% 10 Public Health Services 13% 9 Environmental Health Services 10% 7 Workplace Health and Safety Services 7% 5 Other Community Health Services (see next page) 10% 7 Note: When interpreting the survey results, please note that although the relative number of responses received for each item is instructive, it is not a definitive measure of the relative importance of one issue compared to another. 4 Seventy-one (71) of the 76 survey respondents answered this question. 8 VCU Community Memorial Hospital Community Health Needs Assessment

13 Exhibit I-3 (continued) Important Community Service Gaps Identified by Survey Respondents (continued) Other Important Community Health Services Gaps Identified by Survey Respondents Response # 1. Need for pulmonologist and dermatologist. 2. Dermatology 3. General Practitioners Responses 4. Glad that VCU-CMH is bringing back more "maternal care". I believe delivering babies at the hospital in South Hill probably needs to be a goal. I served on the now somewhat defunct/in transition "Smart Beginnings Southside" board, and Early Intervention Services for Children was an area we determined needed enhancing. In addition, some Dept. of Social Services reps participated on that board, but they seemed "spread thin". 5. Labor and delivery The demographics of the area warrant a need for additional care of the senior citizens especially intervention services. The elderly don't want to give up their real estate in order to receive services or to benefit from Medicaid. Therefore, they need home health services and transportation to receive primary health care services. We have many children living in poverty in our area. They are coming to school already behind developmentally. Workshops for families would be beneficial in the areas of nutrition, literacy, and stages of growth and development. Schools share nurses, and in emergencies a nurse is not always available. Speech services are also needed for young children. 9 VCU Community Memorial Hospital Community Health Needs Assessment

14 4. Community Specialty Medical Services Gaps Survey respondents were asked to review a list of medical services that are typically important for addressing specialty health care needs of a community. Respondents were asked to identify from the list any specialty medical services they think need strengthening in terms of availability, access, or quality. Respondents were also invited to identify additional service gaps not already defined on the list. Exhibit I-4 summarizes the results, including openended responses. Exhibit I-4 Gaps in Specialty Medical Services Identified by Survey Respondents Answer Options Response Percent 5 Response Count Cardiologists 61% 43 Dermatologists 63% 45 Family Practice Physicians 66% 47 Geriatricians 51% 36 Pediatricians 55% 39 Oncologists 38% 27 Urologists 34% 24 Other-Specialty Medical Care Services (list in box below) 9% 6 Other Important Community Health Services Gaps Identified by Survey Respondents Response # Responses 1. Endocrinologist, Infectious Disease Specialist, Pulmonologists 2. Infectious disease 3. Natural and holistic practitioners Need access to primary care, need urgent care option vs. having to go to emergency room and/or sitting for hours in primary care waiting room. Nephrologists, visual and hearing specialists, podiatrists are not on the list. There are people who drive 70+ miles to receive services for items checked in the list above to avoid waiting all day in a health care facility. 6. Obstetrical/gynecological services 7. Orthopedics; pain management 8. Podiatrist, Urgent Care Facility 9. Psychologists/Psychiatrists/Mental Health Counselors. 5 Seventy-one (71) of the 76 survey respondents answered this question. 10 VCU Community Memorial Hospital Community Health Needs Assessment

15 5. Vulnerable/At-Risk Populations in the Community Survey respondents were asked if there are particular populations within the community who are vulnerable/at-risk for health concerns or difficulties obtaining health services. Exhibit I-5 summarizes the results, including representative comments. 6 Exhibit I-5 Vulnerable/At-Risk Populations Identified by Survey Respondents Vulnerable/At-Risk Population Category Elderly Children Low Income, Unemployed, Under- Employed Representative Comments 7 1. Elderly and aging populations need help especially those with little or no family support. 2. I believe the elderly population to be most at risk for health concerns. 3. Elderly with mental and health issues. 4. Elderly and children of high risk for abuse and neglect. 5. Long term care for the elderly. 6. Elderly (70+): number is increasing and this population is prone to medical issues, chronic conditions. 7. Low-and moderate-income families, elderly, and children of low-income families. 8. Physical therapy for the elderly and disabled need to be provided as an in-home service on a regular schedule. 9. I think all populations are at risk for various health care problems. The elderly and children are at greatest risk. 10. The elderly - with being underinsured & having to choose between paying for medications or medical care versus buying food or buying oil or gas/electric for heating their home. 11. The aging poor as well as young children from poverty stricken homes. 1. Children at high risk for abuse and neglect. 2. Children of low-income families. 3. Were it not for a grant in our school system (Essilor Vision Foundation), many students would not have received eye exams and eyeglasses this school year. Parents readily take their children to the emergency room in non-emergency situations. 4. I think all populations are at risk for various health care problems. The elderly and children are at greatest risk. 5. Children need healthier ways to get exercise and learn good nutritional habits. Also, dental care is not always a priority for some of the students I teach. The ones who do have braces have to drive out of town to get them. 6. A high percentage of students in the public school system receive free or reduced lunch. 7. The aging poor as well as young children from poverty stricken homes. 1. Low -and moderate- income families, elderly, and children of low - income families. 2. Those low income families, that include single-parent households, the unemployed and underemployed. 3. Many low income people in this area go without seeing a doctor or waiting so long it necessitates a trip to the emergency room. 4. Working low income families that cannot receive assistance because they are employed. 5. We have a large number of low to moderate income residents. 6. Senior, low income folks who reside in outlying areas. 7. Low income, single parent families. 6 Forty-two (42) of the 76 survey respondents answered this question. Most responses included multiple at-risk populations. 7 Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the Exhibit represent the range of populations identified. 11 VCU Community Memorial Hospital Community Health Needs Assessment

16 Vulnerable/At-Risk Population Category Those without Reliable Transportation Hispanic Community Exhibit I-5 (continued) Vulnerable/At-Risk Populations Identified by Survey Respondents (continued) Representative Comments 8 1. Seniors without reliable transportation. Transportation for non-medical appointments, i.e. grocery store, pharmacy consults. 2. I've heard of transportation issues in this area. 3. There are many marginalized groups that have little training, remain unemployed, and/or have no transportation. 1. Hispanics; single mothers 2. Hispanics. 8 Many respondents identified the same types of populations (e.g. elderly), although with slightly different language. The populations listed in the Exhibit represent the range of populations identified. 12 VCU Community Memorial Hospital Community Health Needs Assessment

17 6. Vulnerable/At-Risk Regions Survey respondents were asked if there are particular neighborhoods or geographic regions within the community where residents may be vulnerable/at-risk for health problems or difficulties obtaining health services. Exhibit I-6 summarizes the results, including representative comments. 9 Exhibit I-6. Vulnerable/At-Risk Neighborhoods or Geographic Regions Identified by Survey Respondents Vulnerable/At-Risk Neighborhood/Geographic Regions Representative Comments 10 Rural Areas 1. Given that the area primarily remains rural, I would say that nearly all of the area has needs. 2. Rural areas where aging can't drive and are unaware of their needs or services available. 3. Rural areas, more than miles in county. 4. As we have many, very rural areas, I would suspect that there are some who may be less likely to seek out health services. I could not identify by neighborhood, however. 5. Generally speaking, rural areas such as the Southside PDC region. 6. There is no geographic community that is more vulnerable than another in this rural area which has been a major farming locality of tobacco. 7. Rural areas with the lack of transportation. 8. I sense that the more rural the neighborhood, the harder it is to obtain health services. South Hill, Mecklenburg, Brunswick, Lunenburg, Circle Drive 1. Bracey, South Hill, many areas need outreach and transportation to help get benefits to them. 2. My sense/hunch is that Chase City is behind Clarksville and South Hill as a town with access. 3. I'm not sure if I can pin-point a particular neighborhood or region in the community, but there is no public transportation available in South Hill or the surrounding communities. 4. Circle Drive, South Hill. 5. The entire Mecklenburg, Brunswick and Lunenburg area; honestly. 6. Circle Drive. The Grove. Mecklenburg Manor. Trailer park near the post office. 7. Lunenburg, Mecklenburg & Brunswick 9 Twenty-eight (28) of the 76 survey respondents answered this question. Most responses included multiple at-risk populations. 10 Many respondents identified the same types of geographic regions (e.g. South Hill), although with slightly different language. The populations listed in the Exhibit represent the range of populations identified. 13 VCU Community Memorial Hospital Community Health Needs Assessment

18 7. Additional Ideas and Suggestions Survey respondents were given the option to submit additional ideas and suggestions for improving community health. The open-ended responses are listed below. Additional Ideas and Suggestions Provided by Respondents Response # Reponses Two great areas for growth: Family Physicians - The options in town are less than desirable. 2. Long Term Care - large opportunity for a local area with our aging population A language barrier sometimes exists because English is spoken with a heavy accent. Patients need to be able to clearly understand and communicate with their health care provider. 2. We also need more family/internal medicine physicians so that there is not a several day wait for treatment. 3. All patient care is important. Bedside manner and communicating well across patient, doctor and nurses is imperative. The emergency room process and timeline has to be quicker and more efficient. Also a lot of people will travel out of the area for a Patient First or Better Med option due to convenience and speed of care especially on the weekends, but if the options were local they would stay. 4. Any of the times I have been in your hospital I feel that I have been very well taken care of. It has been some time since I have been there overnight, but I remember being awakened very early to get my blood pressure, temperature, etc. Then being asked how I slept - removed that question as I was sleeping very well until they woke me up. 5. Bringing back the OB department and adding dermatology would be terrific for our community! 6. Continue to reach out to those less fortunate 7. Educating parents about the importance of child development during the ages of 0-3 would benefit our communities. I have seen a babysitter feeding a 3 month-old pieces of hot dog; another child care individual Education concerning health care has become extremely necessary in order for (especially) low informed people to understand the issues of health care, primarily the cost (not just monetary). The notion that health 8. care is free, that emergency rooms are for emergencies (not for a primary care visit), preventative health care is very important, and out-of-wedlock/teenage pregnancies can be devastating to families, and the economy are some of the educational concerns that need to be understood Expand educational and outreach programs on various health topics. 2. Ensure Veterans have access to care (many have to travel outside the region to get care). 3. Expand access to dental care for low income families. 4. Encourage use of alternative medicines and therapies. 5. Healthy Eating 10. Great progress has been made since the affiliation in meeting some of the deficiencies noted in the survey. 11. With the announcement of the definitive plan to build a new hospital in the next two years, I think more will & Have a signed death certificate with each body at the time of removal by funeral home I am very thankful for our local hospital and all the employees, doctors, nurses, volunteers, administrators and board members, who day after day take care of our community and the visitors to our area. You should be proud of your accomplishments! VCU CMH is a great marriage, together you will fulfill a greater vision and hope for the people in our area. You are greatly appreciated! I believe support groups for many would be a tremendous help to this community, parenting classes, caring for the elderly, education for teens about drug abuse, sexual responsibilities and repercussions, a safe place possibly hotline for high risk teens. hot lines for domestic abuse. I believe the hospital needs a physician liaison that could help with physician relations, keep our physicians informed about new providers and services as well keep our physicians connected/involved with the hospital. 14 VCU Community Memorial Hospital Community Health Needs Assessment

19 Additional Ideas and Suggestions Provided by Respondents Response # 15. Reponses I believe VCU Community Memorial to be achieving its mission at a very high level. 16. I believe VCU-CMH does provide good healthcare but it amazes me how many people go to other hospitals from this are for even simple procedures I do not use any of the local options for health care, so I do not feel comfortable commenting when I really do not know. I like the idea of having the hospitalist program being locally operated. I think the more providers we could have here who are truly committed to this community and its residents, the better the care is going to be over the long-term. I think "care" is the key word in healthcare, and in any endeavor for that matter. In addition to employing people who are properly qualified and certified, I think employing people who truly care about what they're doing and the people they're serving goes a long way toward providing a high quality in healthcare. I like the plans for the new hospital and VCU officials' statement that they desire to bring as many services to South Hill as possible. This is great news for our region! 20. I like the way you are going I think building the new hospital and affiliation with VCU will raise the image of the service. I think there have been some good relationships in the past with VCU such as bringing in [name of new doctor] that have improved the image and service. Bringing in these docs that locals can see without travel to Richmond is great. Geriatric care is lacking here too. I think VCU Community Memorial Hospital has done a great job in serving the locale and surrounding community population. I would like to share my personal experience with VCU-CMH. I was one of the members who was treated after the RRSA accident. You will not find a Hospital anywhere in my eyes who will do what you all did for us and our families. The level of care for not only the patient but also our families was top notch. We could not have asked for anything better than the dedication that was given to us. So if I could add one thing it would be to always stay community based and remember that the local Emergency Services community has always and will always be here to support each other. 24. I'm glad you're coming. I think everyone in our community is excited about the prospect of better healthcare services. 25. Keep moving in the positive direction VCU/CMH is moving for the future. The VCU affiliation is a positive for our community and that has been noticed by additional specialists and physicians moving to our area. 26. Labor and Delivery services on the hospital are a must for growth of the area. We recently lost a few young adult professionals to a larger area where they had access to these services. 27. More health education in areas remote from South Hill. Lake area. 28. Our physicians are aging and are not as caring in the past 20 years. It is zeal about the bottom line and it shows in people going out of town for urgent care for their family. 29. Partner with the existing agencies to help improve the services already provided. 30. Partnering more with local entities like churches--and like "Smart Beginnings Southside". 31. Quality of services offered are critical. Many in our area have had bad experiences at CMH and travel to Richmond, etc. for Health Care. I have had positive experiences at CMH but would hope the merger with VCU will offer additional services here with improved customer satisfaction. 32. The VCU Massey Cancer Outreach office in Lawrenceville is an asset to the aging population in the community. 33. VCU/CMH does a good job of taking care of our community's medical needs but expanding our specialty physicians and services will have a major impact on the value of the hospital and the overall health of Southside Virginia and Northern NC. 15 VCU Community Memorial Hospital Community Health Needs Assessment

20 Part II. Community Indicator Profile This section of the report provides a quantitative profile of the study region based on a wide array of community health indicators. To produce the profile, Community Health Solutions analyzed data from multiple sources. By design, the analysis does not include every possible indicator of community health. The analysis is focused on a set of indicators that provide broad insight into community health and for which there were readily available data sources. The results of this profile can be used to evaluate community health status compared to the Commonwealth of Virginia overall. The results can also be helpful for determining the number of people affected by specific health concerns. In addition, the results can be used alongside the Community Insight Survey results and the zip code level maps to help inform action plans for community health improvement. This section includes ten profiles as follows: 1. Health Demographic Trend Profile 2. Health Demographic Snapshot 3. Mortality Profile 4. Maternal and Infant Health Profile 5. Preventable Hospitalization Profile 6. Behavioral Health Hospital Discharge Profile 7. Adult Health Risk Factor Profile 8. Youth Health Risk Factor Profile 9. Uninsured Profile 10. Medically Underserved Profile 16 VCU Community Memorial Hospital Community Health Needs Assessment

21 1. Health Demographic Trend Profile Trends in health-related demographics are instructive for anticipating changes in community health status. Changes in the size, age and racial/ethnic mix of the population can have a significant impact on overall health status, health needs and demand for local services. As shown in Exhibit II-1, as of 2014, the study region included an estimated 81,737 people. The population is expected to increase to 82,151 by Focusing on trends from 2010 to 2019, it is projected that population growth of 14 percent will occur in the senior population age 65+, with declining populations expected in other age groups. Focusing on race and ethnicity, growth is expected within the Asian, Other or Multi-Race, and Hispanic population groups, with declines expected in the White and Black/African American population segments. Indicator+ Exhibit II-1 Health Demographic Trend Profile, Census 2014 Estimate 2019 Projection % Change Total Population 85,651 81,737 82,151-4% Population Density (per Sq. Mile) % Total Households 33,934 32,794 33,245-2% Population by Age Children Age ,406 16,376 15,946-8% Adults Age ,588 11,057 11,353-2% Adults Age ,958 13,742 13,337-11% Adults Age ,600 24,403 23,208-9% Seniors Age ,089 16,159 18,305 14% Population by Race/Ethnicity Asian % Black/African American 33,529 31,204 31,848-5% White 49,289 47,428 46,819-5% Other or Multi-Race 2,467 2,614 2,964 20% Hispanic Ethnicity 11 2,189 2,267 2,493 14% Source: Community Health Solutions analysis of US Census data and estimates from Alteryx, Inc. See Appendix B. Data Sources for details. 11 Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories. 17 VCU Community Memorial Hospital Community Health Needs Assessment

22 2. Health Demographic Snapshot Community health is driven in part by community demographics. The age, sex, race, ethnicity, income and education status of a population are strong predictors of community health status and community health needs. Exhibit III-2 presents a snapshot of key health-related demographics of the study region. As of 2014, the study region included an estimated 81,737 people. As illustrated by the population rates shown in the lower part of the Exhibit, compared to Virginia as a whole, the study region is more rural, older, and more racially/ethnically diverse. The study region also has lower income and educational attainment among adults than Virginia as a whole. Exhibit III-2 Health Demographic Snapshot Profile, 2014 Indicator Study Region Virginia Population Counts Total Population Population 81,737 8,282,921 Children Age ,376 1,889,338 Age Adults Age ,057 1,417,141 Adults Age ,742 1,678,713 Adults Age ,403 2,241,450 Seniors Age ,159 1,056,279 Sex Female 40,758 4,214,922 Male 40,979 4,067,999 Asian ,905 Race Black/African American 31,204 1,602,827 White 47,428 5,616,313 Other or Multi-Race 2, ,876 Ethnicity Hispanic Ethnicity 12 2, ,701 Income Low Income Households (Households with Income < $25,000) 11, ,210 Education Population Age 25+ Without a High School Diploma 58,688 5,565,986 Population Rates Total Population Population Density (pop. per sq. mile) Children Age 0-17 pct. of Total Pop. 20% 23% Adults Age pct. of Total Pop. 14% 17% Age Sex Race Adults Age pct. of Total Pop. 17% 20% Adults Age pct. of Total Pop. 30% 27% Seniors Age 65+ pct. of Total Pop. 20% 13% Female pct. of Total Pop. 50% 51% Male pct. of Total Pop. 50% 49% Asian pct. of Total Pop. 1% 6% Black/African American pct. of Total Pop. 38% 19% White pct. of Total Pop. 58% 68% Other or Multi-Race pct. of Total Pop. 3% 7% Ethnicity Hispanic Ethnicity pct. of Total Pop. 3% 9% Income Low Income Households (Households with Income <$25,000) pct. of Total Households 35% 19% Education Pop. Age 25+ Without a High School Diploma pct. of Total Pop. Age % 12% Source: Community Health Solutions analysis of estimates from Alteryx, Inc. See Appendix B. Data Sources for details. 12 Classification of ethnicity; therefore, Hispanic individuals are also included in the race categories. 18 VCU Community Memorial Hospital Community Health Needs Assessment

23 3. Mortality Profile Mortality is one of the most commonly cited community health indicators. As shown in Exhibit II-3, the study region had 1,080 total deaths in The leading causes of death were heart disease (275 deaths), malignant neoplasms (cancer) (255 deaths), and cerebrovascular disease (stroke) (83 deaths). The death rates (unadjusted for age) in the study region were higher than Virginia overall and for the top seven causes of death. Note: Maps in Appendix A show the geographic distribution of key death indicators by zip code. Exhibit II-3 Mortality Profile, 2013 Indicator Study Region Virginia Total Deaths Count (Percent of Total) Deaths by All Causes 1,080 62,309 Deaths by Top 14 Causes Heart Disease, Deaths 275 (25%) 13,543 (22%) Malignant Neoplasms, Deaths 255 (24%) 14,348 (23%) Cerebrovascular Diseases, Deaths 83 (8%) 3,278 (5%) Chronic Lower Respiratory Diseases, Deaths 48 (4%) 3,168 (5%) Unintentional Injury, Deaths 43 (4%) 2,794 (4%) Diabetes Mellitus, Deaths 38 (4%) 1,618 (3%) Nephritis and Nephrosis, Deaths 31 (3%) 1,547 (2%) Alzheimer's Disease, Deaths 20 (2%) 1,634 (3%) Influenza and Pneumonia, Deaths 20 (2%) 1,430 (2%) Septicemia, Deaths 19 (2%) 1,464 (2%) Chronic Liver Disease, Deaths 16 (1%) 836 (1%) Suicide, Deaths 13 (1%) 1,047 (2%) Primary Hypertension and Renal Disease, Deaths 13 (1%) 629 (1%) Parkinson s Disease, Deaths 4 (0%) 549 (1%) Crude Rate per 100,000 Population 13 Total Deaths 1, Heart Disease, Deaths Malignant Neoplasms, Deaths Cerebrovascular Diseases, Deaths Chronic Lower Respiratory Diseases, Deaths Unintentional Injury, Deaths Diabetes Mellitus, Deaths Nephritis and Nephrosis, Deaths Alzheimer's Disease, Deaths Influenza and Pneumonia, Deaths Septicemia, Deaths Chronic Liver Disease, Deaths Suicide, Deaths Primary Hypertension and Renal Disease, Deaths Parkinson's Disease, Deaths Source: Community Health Solutions analysis of birth data from the Virginia Department of Health. See Appendix B. Data Sources for details Rates are not calculated where the number of deaths is less than 30. Age-adjusted death rates were not calculated for this study because the study region is defined by zip codes, and available data are not structured to support calculation of age-adjusted death rates at the zip code level, a crude rate is provided as an alternative. 19 VCU Community Memorial Hospital Community Health Needs Assessment

24 4. Maternal and Infant Health Profile As shown in Exhibit II-4A, the study region had 778 total live births in Of these, 89 (11%) were born with low birth weight, 155 (20%) were births without early prenatal care, 407 (52%) were non-marital births, and 70 were births to teens [with most (56) involving older teens age 18 or 19]. Compared to Virginia as a whole, the study region had higher rates of low weight births, births without early prenatal care, and non-marital births. Note: Maps in Appendix A show the geographic distribution of key birth indicators by zip code. Exhibit II-4A Maternal and Infant Health Profile, 2013 Indicators Study Region Virginia Counts Total Live Births ,977 Low Weight Births (under 2,500 grams / 5 lb. 8 oz.) 89 8,178 Births Without Early Prenatal Care (No Prenatal Care in First 13 Weeks) ,435 Non-Marital Births ,289 Live Births to Teens Age ,316 Live Births to Teens Age ,073 Live Births to Teens Age ,208 Live Births to Teens Age < Rates 14 Live Birth Rate per 1,000 Population Low Weight Births pct. of Total Live Births 11% 8% Births Without Early Prenatal Care (No Prenatal Care in First 13 Weeks) pct. of Total Live Births 20% 13% Non-Marital Births pct. of Total Live Births 52% 35% Live Births to Teens Age Live Births to Teens Age Live Births to Teens Age Source: Community Health Solutions analysis of birth data from the Virginia Department of Health. See Appendix B. Data Sources for details. For technical reasons, it was not possible to calculate teen pregnancy rates or five-year infant mortality rates at the zip code level. 15 As an approximation, Exhibit II-4B on the following page shows counts and rates of infant mortality and teen pregnancy for the counties that overlap the study region. The five-year infant mortality rates were higher than the statewide rate for four of the five counties, the exception being Lunenburg County. Teen pregnancy rates were also higher than the statewide rate for four of the five counties, the exception being Mecklenburg County Rates are not calculated where the count is less than Infant mortality and teen pregnancy rates were not calculated for this study region because the study region is defined by zip codes, and available data are not structured to support calculation of rates at the zip code level. City/county level rates are provided as an alternative. 20 VCU Community Memorial Hospital Community Health Needs Assessment

25 Exhibit II-4B Infant Mortality and Teen Pregnancy, 2013 Indicators Virginia Brunswick County Charlotte County Lunenburg County Mecklenburg County Nottoway County Counts Total Infant Deaths (2013) Total Teenage (age 10-7, ) Pregnancies (2013) Rates Five-Year Average Infant Mortality Rate per 1,000 Live Births ( ) Teenage (age 10-19) Pregnancy Rate per 1,000 Teenage Female Population (2013) VCU Community Memorial Hospital Community Health Needs Assessment

26 5. Preventable Hospitalization Discharge Profile The Agency for Healthcare Research and Quality (AHRQ) identifies a defined set of conditions (called Prevention Quality Indicators, or PQIs ) for which hospitalization should be avoidable with proper outpatient health care. 16 High rates of hospitalization for these conditions indicate potential gaps in access to quality outpatient services for community residents. As shown in Exhibit II-5, residents of the study region had 1,705 PQI hospital discharges in The leading diagnoses for these discharges were chronic obstructive pulmonary disease (COPD) and asthma in older adults (449), congestive heart failure (445), diabetes (240), and bacterial pneumonia (200). The PQI discharge rates for the study region were higher than the Virginia statewide rates PQI diagnoses overall and for the seven leading causes. Note: A map in Appendix A shows the geographic distribution of total PQI discharges by zip code. Exhibit II-5 Prevention Quality Indicator (PQI) Hospital Discharge Profile, 2013 Indicator Study Region Virginia Total PQI Discharges Count (Percent of Total) Total PQI Discharges by All Diagnoses 1,705 78,768 PQI Discharges by Diagnosis COPD or Asthma In Older Adults, PQI Discharges 449 (26%) 16,026 (20%) Congestive Heart Failure, PQI Discharges 445 (26%) 18,239 (23%) Diabetes, PQI Discharges 240 (14%) 11,099 (14%) Bacterial Pneumonia, PQI Discharges 200 (12%) 11,867 (15%) Dehydration, PQI Discharges 153 (9%) 7,743 (10%) Urinary Tract Infection, PQI Discharges 144 (8%) 8,452 (11%) Perforated Appendix, PQI Discharges 32 (2%) 1,189 (2%) Hypertension, PQI Discharges 25 (1%) 2,768 (4%) Angina, PQI Discharges 11 (1%) 444 (1%) Asthma in Younger Adults, PQI Discharges 6 (0%) 941 (1%) Rates-Per 100,000 Population 18 Total Prevention Quality Indicator (PQI) Discharges 2, COPD or Asthma In Older Adults, PQI Discharges Congestive Heart Failure, PQI Discharges Diabetes, PQI Discharges Bacterial Pneumonia, PQI Discharges Dehydration, PQI Discharges Urinary Tract Infection, PQI Discharges Perforated Appendix, PQI Discharges Hypertension, PQI Discharges Angina, PQI Discharges Asthma in Younger Adults, PQI Discharges Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local demographic estimates from Alteryx, Inc. See Appendix B. Data Sources for details. 16 The PQI definitions are detailed in their specification of ICD-9 diagnosis codes and procedure codes. Not every hospital admission for congestive heart failure, bacterial pneumonia, etc. is included in the PQI definition; only those meeting the detailed specifications. Low birth weight is one of the PQI indicators, but for the purpose of this report, low birth weight is included in the Maternal and Infant Health Profile. Also, there are four diabetes-related PQI indicators which have been combined into one for the report. For more information, visit the AHRQ website at 17 Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis Rates are not calculated where the number of PQI discharges is less than 30. Age-adjusted rates were not calculated for this study because the study region is defined by zip codes, and available data are not structured to support calculation of age-adjusted rates at the zip code level, a crude rate is provided as an alternative. 22 VCU Community Memorial Hospital Community Health Needs Assessment

27 6. Behavioral Health Hospitalization Discharge Profile Behavioral health (BH) hospitalizations provide another important indicator of community health status. As shown in Exhibit II-6, residents of the study region had 626 hospital discharges from Virginia community hospitals for behavioral health conditions in The leading diagnoses for these discharges were affective psychoses (226), schizophrenic disorders (95), and Depressive Disorders (53). The BH discharge rates for the study region were higher than Virginia statewide rates overall and for four of the top five causes, the exception being a lower rate for schizophrenic disorder. Note: A map in Appendix A shows the geographic distribution of Total BH discharges by zip code. Exhibit II-6 Behavioral Health Hospital Discharge Profile, 2013 Indicator Study Region Virginia BH Discharges Count (Percent of Total) Total BH Discharges by All Diagnoses ,600 BH Discharges by Diagnosis Affective Psychoses, BH Discharges 226 (36%) 26,709 (44%) Schizophrenic Disorders, BH Discharges 95 (15%) 8,136 (13%) Depressive Disorder, Not Elsewhere Classified, BH Discharges 53 (8%) 3,503 (6%) Other Nonorganic Psychoses, BH Discharges 34 (5%) 2,133 (4%) Senility Without Mention Of Psychosis, BH Discharges 33 (5%) 1,688 (3%) Other Organic Psychotic Conditions-Chronic, BH Discharges 28 (4%) 795 (1%) Alcoholic Psychoses, BH Discharges 25 (4%) 4,037 (7%) Altered Mental Status, BH Discharges 25 (4%) 1,000 (2%) Neurotic Disorders, BH Discharges 17 (3%) 1,207 (2%) Alcohol Dependence Syndrome, BH Discharges 15 (2%) 2,391 (4%) Symptoms Involving Head or Neck, BH Discharges 14 (2%) 933 (2%) Adjustment Reaction, BH Discharges 12 (2%) 2,271 (4%) Non Dependent Abuse of Drugs, BH Discharges 11 (2%) 600 (1%) Drug Psychoses, BH Discharges 5 (1%) 2,121 (4%) Drug Dependence, BH Discharges 4 (1%) 816 (1%) Rates-Per 100,000 Population 20 Total Behavioral Health (BH) Discharges, BH Discharges Affective Psychoses, BH Discharges Schizophrenic Disorders, BH Discharges Depressive Disorder, Not Elsewhere Classified, BH Discharges Other Nonorganic Psychoses, BH Discharges Senility Without Mention of Psychosis, BH Discharges Other Organic Psychotic Conditions-Chronic, BH Discharges Alcoholic Psychoses, BH Discharges Altered Mental Status, BH Discharges Neurotic Disorders, BH Discharges Alcohol Dependence Syndrome, BH Discharges Symptoms Involving Head or Neck, BH Discharges Adjustment Reaction, BH Discharges Non Dependent Abuse of Drugs, BH Discharges Drug Psychoses, BH Discharges Drug Dependence, BH Discharges Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information, Inc. and local demographic estimates from Alteryx, Inc. See Appendix B. Data Sources for details. 19 Data include discharges for Virginia residents from Virginia community hospitals reporting to Virginia Health Information, Inc. These data do not include discharges from state behavioral health facilities or federal (military) facilities. Data reported are based on the primary diagnosis Rates are not calculated where the number of discharges is less than VCU Community Memorial Hospital Community Health Needs Assessment

28 7. Adult Health Risk Factor Profile This profile presents indicators of adult health risks for adults age 18+ based on analysis of data from the Virginia Behavioral Risk Factor Surveillance Survey and demographic data from Alteryx, Inc. (see Appendix B for details on methods.) Please note that all indicators in this profile are estimates based on statistical analysis of survey data, and therefore subject to estimation error. As shown in Exhibit II-7. Adult Health Risk Factor Profile (2014-Estimates), substantial numbers of adults have lifestyle health risks related to nutrition, weight, physical inactivity, tobacco and alcohol. Please note that these estimates reflect general patterns based on statistical analysis of multiple years of survey data. Because of data limitations, it is not possible to assign specific margins of error or levels of significance to these statistical estimates. Note: Maps in Appendix A show the geographic distribution of key adult health risk estimates by zip code. Indicator Estimates-Counts Exhibit II-7 Adult Health Risk Factor Profile (2014-Estimates) Study Region Estimated Adults age ,361 Lifestyle Risk Factors Chronic Conditions Less than Five Servings of Fruits and Vegetables Per Day 54,691 Overweight or Obese 43,025 Not Meeting Recommendations for Physical Activity in the Past 30 Days 32,204 At-risk for Binge Drinking (males having five or more drinks on one occasion, females having four or more drinks on one occasion) 9,027 Smoker 14,480 High Cholesterol (was checked, and told by a doctor or other health professional it was high) 23,184 High Blood Pressure (told by a doctor or other health professional) 21,093 Arthritis (told by a doctor or other health professional) 17,858 Diabetes (told by a doctor or other health professional) 6,921 General Health Status Limited in any Activities because of Physical, Mental or Emotional Problems 13,582 Fair or Poor Health Status 10,468 Estimates-Rates Lifestyle Risk Factors Chronic Conditions General Health Status Less than Five Servings of Fruits and Vegetables Per Day 84% Overweight or Obese 66% Not Meeting Recommendations for Physical Activity in the Past 30 Days 49% At-risk for Binge Drinking (males having five or more drinks on one occasion, females having four 14% or Smoker more drinks on one occasion) 22% High Cholesterol (was checked, and told by a doctor or other health professional it was high) 35% High Blood Pressure (told by a doctor or other health professional) 32% Arthritis (told by a doctor or other health professional) 27% Diabetes (told by a doctor or other health professional) 11% Limited in any Activities because of Physical, Mental or Emotional Problems 21% Fair or Poor Health Status 16% 24 VCU Community Memorial Hospital Community Health Needs Assessment

29 8. Youth Health Risk Factor Profile This profile presents estimates of health risks for youth age and The indicators in this profile are estimates based on analysis of data from the Virginia Youth Risk Behavioral Surveillance System from the Centers for Disease Control (2013) and demographic data from Alteryx, Inc. (see Appendix B for details on methods.) Please note that all indicators in this profile are estimates, and therefore subject to estimation error. As shown in Exhibit II-8. Youth Health Risk Factor Profile (2014-Estimates), substantial numbers of youth have lifestyle health risks related to nutrition, weight, alcohol, mental health, physical inactivity, and tobacco. Please note that these estimates reflect general patterns based on statistical analysis of survey data. Because of data limitations, it is not possible to assign specific margins of error or levels of significance to these statistical estimates. Note: A map in Appendix A shows the geographic distribution of estimated overweight and obese youth age by zip code. Exhibit II-8 Youth Health Risk Factor Profile (2014 Estimates) Indicator Counts (Estimates) Study Region High School Youth Age Total Estimated High School Youth Age ,907 Met Guidelines for Fruit and Vegetable Intake 476 Overweight or Obese 1,717 Not Meeting Recommendations for Physical Activity in the Past Week 3,260 Used Tobacco in the Past 30 Days 1,077 Had at least One Drink of Alcohol At least One Day in the Past 30 Days 1,597 Felt Sad or Hopeless (almost every day for two or more weeks in a row so that 1,406 Middle School they Youth stopped Age doing some usual activities) Total Estimated Middle School Youth Age ,303 Met Guidelines for Fruit and Vegetable Intake 563 Not Meeting Recommendations for Physical Activity in the Past Week 791 Used Tobacco in the Past 30 Days 55 Rates (Percent Estimates) High School Youth Age Met Guidelines for Fruit and Vegetable Intake 8% Overweight or Obese 29% Not Meeting Recommendations for Physical Activity in the Past Week 55% Used Tobacco in the Past 30 Days 18% Had at least One Drink of Alcohol At least One Day in the Past 30 Days 27% Felt Sad or Hopeless (almost every day for two or more weeks in a row so that 24% Middle School they Youth stopped Age doing some usual activities) Met Guidelines for Fruit and Vegetable Intake 24% Not Meeting Recommendations for Physical Activity in the Past Week 34% Used Tobacco in the Past 30 Days 2% 25 VCU Community Memorial Hospital Community Health Needs Assessment

30 9. Uninsured Profile This profile presents estimates of the uninsured population within the 0-64 age group. The indicators in this profile are estimates based on analysis of data from the U.S. Census Bureau Small Area Health Insurance Estimates and demographic estimates from Alteryx, Inc. (see Appendix B for details on methods.) These are snapshot indicators that estimates the number of uninsured at a specific point in time. Please note that all indicators in this profile are subject to estimation error. Note: Maps in Appendix A show the geographic distribution of key adult and child uninsured estimates by zip code. As shown in Exhibit II-9. Uninsured Profile (2014 Estimates): At any specific point in 2014, an estimated 12,721 residents of the study region were uninsured. The estimated number of uninsured children age 0-18 was 1,489 in the study region. Among uninsured children, it is estimated that roughly half have family income below 200 percent of the federal poverty level, possibly making them income-eligible for coverage through the state Medicaid or FAMIS program. The estimated number of uninsured adults age was 11,231 in the study region. Among uninsured adults, it is estimated that more than half have family income below 200 percent of the federal poverty level. Indicator Estimated Uninsured Counts* Exhibit II-9 Uninsured Profile (2014 Estimates) Study Region Uninsured Nonelderly Age ,721 Uninsured Children Age ,489 Uninsured Children Age 0-18 <=138% FPL 483 Uninsured Children Age 0-18 <=200% FPL 748 Uninsured Children Age 0-18 <=250% FPL 918 Uninsured Children Age 0-18 <=400% FPL 1,221 Uninsured Children Age % FPL 738 Uninsured Adults Age ,231 Uninsured Adults Age <=138% FPL 4,113 Uninsured Adults Age <=200% FPL 6,031 Uninsured Adults Age <=250% FPL 7,270 Uninsured Adults Age <=400% FPL 9,421 Uninsured Adults Age % FPL 5,308 Estimated Uninsured Percent Uninsured Children Percent 9% Uninsured Adults Percent 23% *FPL Categories are cumulative Source: Community Health Solutions analysis of U.S. Census Bureau s Small Area Health Insurance Estimates data. See Appendix B Data Sources for details. 26 VCU Community Memorial Hospital Community Health Needs Assessment

31 10. Medically Underserved Profile Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the U.S. Health Resources and Services Administration as being at-risk for health care access problems. The designations are based on several factors including primary care provider supply, infant mortality, prevalence of poverty and the prevalence of seniors age 65+. As shown in Exhibit II-10, As shown in Exhibit II-10, all five counties that overlap the study region have been designated as MUAs. For a more detailed description, visit the U.S. Health Resources and Service Administration designation webpage at Locality Exhibit II-10. Medically Underserved Areas and Populations MUA/MUP designation Census Tracts Brunswick County Full 14 of 14 Census Tracts Charlotte County Full 13 of 13 Census Tracts Lunenburg County Full 14 of 14 Census Tracts Mecklenburg County Full 27 of 27 Census Tracts Nottoway County Full 14 of 14 Census Tracts Source: Community Health Solutions analysis of U.S. Health Resources and Services Administration data. See Appendix B Data Sources for details. 27 VCU Community Memorial Hospital Community Health Needs Assessment

32 APPENDIX A: Zip Code-Level Maps The Zip Code-Level maps in this section illustrate the geographic distribution of the zip code-level study region on key health status indicators. Following the maps is a table with the underlying data. The maps in this section include the following for 2013/2014: 1. Total Deaths, Estimated Adult Age 18+ Smokers, Heart Disease Deaths, Estimated Adults Age 18+ with No Dental Visit in 3. Cerebrovascular Disease (Stroke) Deaths, the Estimated Last Year, Adults 2014 Age 18+ with Diabetes, Malignant Neoplasm (Cancer) Deaths, Estimated Adults Age 18+ who are Overweight or 5. Total Live Births, Obese, Estimated 2014 High School-aged Youth (age 14-19) who are Overweight or Obese, Total Teenage Live Births (age<17), Estimated Uninsured Children Age 0-18, Total Prevention Quality Indicator Hospitalization 8. Discharges, Total Behavioral 2013 Health Hospitalization Discharges, Estimated Uninsured Adults, Age 19-64, 2014 **Technical Notes** 1. The maps and data include 38 zip codes, as identified by VCU Community Memorial Hospital, most of which fall within Brunswick, Charlotte, Lunenburg, Mecklenburg and Nottoway counties. It is important to note that zip code boundaries do not automatically align with city/county boundaries, and there are some zip codes that extend beyond the county boundaries. Also, not all zip codes in each of above mentioned localities were identified by VCU Community Memorial Hospital as part of the Zip Code-Level Study Region 2. The maps show counts rather than rates. Rates are not mapped at the zip code-level because in some zip codes the population is too small to support rate-based comparisons. 3. Data are presented in natural breaks. 4. Zip Code-Level Study Region zip codes with zero values are noted. 28 VCU Community Memorial Hospital Community Health Needs Assessment

33 Map 1: Total Deaths, 2013 Source: Community Health Solutions analysis of death record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 29 VCU Community Memorial Hospital Community Health Needs Assessment

34 Map 2: Heart Disease Deaths, 2013 Source: Community Health Solutions analysis of death record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 30 VCU Community Memorial Hospital Community Health Needs Assessment

35 Map 3: Cerebrovascular Disease (Stroke) Deaths, 2013 Source: Community Health Solutions analysis of death record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 31 VCU Community Memorial Hospital Community Health Needs Assessment

36 Map 4: Malignant Neoplasm (Cancer) Deaths, 2013 Source: Community Health Solutions analysis of death record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 32 VCU Community Memorial Hospital Community Health Needs Assessment

37 Map 5: Total Live Births, 2013 Source: Community Health Solutions analysis of birth record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 33 VCU Community Memorial Hospital Community Health Needs Assessment

38 Map 6: Total Teenage Live Births (age <17), 2013 Source: Community Health Solutions analysis of birth record data from the Virginia Department of Health. See details in methods in Appendix B Data Sources for details. 34 VCU Community Memorial Hospital Community Health Needs Assessment

39 Map 7: Total Prevention Quality Indicator (PQI) Hospitalization Discharges, 2013 Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information and demographic data from Alteryx, Inc. See details on methods in Appendix B Data Sources for details. 35 VCU Community Memorial Hospital Community Health Needs Assessment

40 Map 8: Total Behavioral Health (BH) Hospitalization Discharges, 2013 Source: Community Health Solutions analysis of hospital discharge data from Virginia Health Information and demographic data from Alteryx, Inc. See details on methods in Appendix B Data Sources for details. 36 VCU Community Memorial Hospital Community Health Needs Assessment

41 Map 9: Estimated Adults Age 18+ Smokers, 2014-Estimates Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data and local demographic estimates from Alteryx, Inc. See details in methods in Appendix B Data Sources for details. 37 VCU Community Memorial Hospital Community Health Needs Assessment

42 Map 10: Estimated Adults Age 18+ with No Dental Visit in the Last Year, 2014-Estimates Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data and local demographic estimates from Alteryx, Inc. See details in methods in Appendix B Data Sources for details. 38 VCU Community Memorial Hospital Community Health Needs Assessment

43 Map 11: Estimated Adults Age 18+ with Diabetes, Estimates Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data and local demographic estimates from Alteryx, Inc. See details in methods in Appendix B Data Sources for details. 39 VCU Community Memorial Hospital Community Health Needs Assessment

44 Map 12: Estimated Adults Age 18+ who are Overweight or Obese, 2014-Estimates Source: Estimates produced by Community Health Solutions using Virginia Behavioral Risk Factor Surveillance System data and local demographic estimates from Alteryx, Inc. See Appendix B Data Sources for details. 40 VCU Community Memorial Hospital Community Health Needs Assessment

45 Map 13: Estimated High School-aged Youth (age 14-19) who are Overweight or Obese, 2014-Estimates Source: Estimates produced by Community Health Solutions using Virginia Youth Risk Behavioral Surveillance System data and local demographic estimates from Alteryx, Inc. See Appendix B Data Sources for details. 41 VCU Community Memorial Hospital Community Health Needs Assessment

46 Map 14: Estimated Uninsured Children, Age 0-18, 2014-Estimates. Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area Health Insurance Estimates (2013) and demographic data from Alteryx, Inc. See Appendix B Data Sources for details. 42 VCU Community Memorial Hospital Community Health Needs Assessment

47 Map 15: Estimated Uninsured Adults, Age 19-64, Estimates Source: Estimates of uninsured are based on Community Health Solutions analysis of U.S. Census Bureau Small Area. Health Insurance Estimates (2013) and demographic data from Alteryx, Inc. See Appendix B Data Sources for details. 43 VCU Community Memorial Hospital Community Health Needs Assessment